Crisis events and school mental health referral patterns of young children.

Conducted 2 studies investigating the impact of 2 types of potential crisis-producing experiences on the referral patterns of maladapting 5-10 yr old school children: parental separation and divorce and parental death. Ss in Study 1 were 108 children with a history of parental separation or divorce and 32 with a history of parent death. Study 2 used 226 Ss, 188 with separation-divorce histories and 38 with parental death histories. Both "crisis" groups were compared first to demographically matched referred controls, without crisis histories, and then directly to each other. Each crisis group had a significantly higher overall maladjustment score than its respective control group. Ss with histories of parent death were significantly more anxious, depressed, and withdrawn than their matched controls; whereas separation-divorce Ss had significantly more aggression and acting-out problems than their controls. These effects remained (a) when initial maladjustment differences were ruled out and (b) in a direct comparison of matched death and divorce Ss. The association between specific crisis history and specific school maladjustment patterns is seen to have implications for early detection and preventive efforts. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of utilization of community primary health care and school health services by urban Mexican-American and Anglo elementary school children

The health care utilization of urban Mexican-American and Anglo elementary school children was recorded at school and community primary-care sites over a 1-year period. No significant differences were found between the two groups with respect to visiting/nonvisiting behavior or frequency of visits. Two unobtrusive measures were used to ascertain the degree of acculturation of the Mexican-American children and their parents: return of Spanish-language questionnaire and enrollment of the child in bilingual classes. No significant differences were found in the proportion of visitors/nonvisitors in each group or the total number of visits for health services among these children. Mexican-American and Anglo children did not differ in the type of health problems presented, except that fewer Mexican-American than Anglo children had visits for emotional, behavioral or learning problems. Results indicate that when health services are available and accessible, and when the barriers of language and income are minimized, Mexican-American and Anglo children do not differ in their use of health services in the community.     

Mental health services for young people: ''inadequate and patchy''

Adolescents requiring inpatient care for anorexia nervosa present an exciting challenge for nurses because of the complex biopsychosocial nature of the illness. Nurses currently play a major role in caring, not only for the physical health of these patients, but for many of their psychological, social and family needs as well. With the strong foundation in holistic care which underpins nursing, scientific research and innovative nursing interventions may well hold the key to improving the current less-than-ideal long-term outcome for young people with anorexia nervosa.     

The challenge of providing psychological services for young handicapped children.

Examines the challenge faced by psychologists to ensure adequate and appropriate assessment and intervention for young children (birth–6 yrs of age) who have developmental disabilities including emotional, cognitive, sensory, and physical handicaps. Three major problem areas are considered: (1) determining who should provide services, (2) defining what clinical procedures are both appropriate and nondiscriminatory, and (3) obtaining training for assessment and treatment. It is concluded that as health care providers and trainers of practitioners, psychologists must seriously consider the challenge of providing the services to handicapped infants and young children. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed care, school health programs, and adolescent health services: opportunities for health promotion

The rapid expansion of managed care creates opportunities and dilemmas for those involved in school health and adolescent health promotion. Managed care organizations (MCOs), public health agencies, and school and adolescent health providers share certain common goals and priorities including an emphasis on prevention, cost-effectiveness, and quality of care--and a willingness to explore innovative approaches to health promotion and disease prevention. However, MCOs often face conflicting challenges, balancing the goals of cost containment and investment in prevention. In considering support for school health programs, MCOs will be interested in evidence about the effectiveness of services in improving health and/or reducing medical expenditures. Mechanisms for improving prevention efforts within MCOs include quality assurance systems to monitor the performance of health plans, practice guidelines from professional organizations, and the contracting process between payers and health care providers. Development of partnerships between MCOs and schools will be a challenge given competing priorities, variation in managed care arrangements, structural differences between MCOs and schools, and variability in services provided by school health programs.     

Issues in mental health services for children and adolescents

Existing system of psychiatric care for children and adolescents is in need of basic reorganization. The authors propose: 1) reestablishment of the speciality of children's and adolescent psychiatrist, a specialist in children's and adolescent narcology, a psychiatrist of early child's age and a pediatric medical psychologist; 2) carrying out the reform of child mental care equal in rights with general psychiatry; 3) preservation and widening of both specialized inpatient and outpatient clinics in general system of child's mental care; 4) legislative and public rehabilitation of children's psychiatry, which suffered considerably from antipsychiatric campaign; 5) professionally organized systematic elevation of psychohygienic, psychiatric and psychotherapeutic knowledges of allied medical and other specialists as well as of parents and of all population too; 6) integration and interaction of govermental services concerning mental health of children and adolescent; 7) organization of regional psychoprophylaxic interdisciplinary centers for children and adolescent.     

Managed behavioral health services for children under carve-out contracts

OBJECTIVE: Service costs and utilization patterns of children in carved-out behavioral health care plans were examined and compared with those of adults. METHODS: Twelve-month data on utilization and costs of behavioral health care from one managed behavioral health care carve-out organization, United Behavioral Health, were examined for three age groups of children--birth to five years, six to 12 years, and 13 to 17 years-and for adults. More than 600,000 enrollees in 108 different plans were included in the data. Rates of use and intensity of use were examined separately by type of service-inpatient, outpatient, and partial hospitalization. RESULTS: Only a small number of all enrollees used any behavioral health care services--4.2 percent used outpatient services, .3 percent used inpatient services, and .2 percent used partial hospitalization services. Adolescents were more than twice as likely as adults and about seven times as likely as children aged 6 to 12 to use inpatient services. Adolescents also had a slightly higher probability of using outpatient care than adults, while younger children had lower rates of outpatient use than adolescents or adults. Adolescents were also more likely than adults and other children to have very high costs of inpatient care (mean costs=$8,975 for adolescents and $4,750 for adults). Adults were more likely than other groups to have higher outpatient costs ($640 for adults and $513 for all children). CONCLUSIONS: The finding that children, and adolescents in particular, are more likely to have very high inpatient costs compared with adults implies that they may benefit most from the elimination of caps on mental health care costs covered by insurance. This profile of children's behavioral health care utilization patterns can be useful to policy makers in considering expansions in children's health insurance coverage.     

The effectiveness of an intervener model of services for young deaf-blind children

Project Validation of the Intervener Program (VIP) studied and documented the effectiveness of the Intervener Service Model which provides the services of a paraprofessional (called an intervener) to families of young children who are deaf-blind. The intervener provides auditory, visual, and tactile stimulation for the child and helps the child develop interactive behaviors instead of isolated, defensive, or self-stimulatory behaviors. The intervener also enables the parents to obtain much needed respite. Project VIP obtained abundant quantitative and qualitative data on the effectiveness of the Intervener Service Model. The data strongly support the need for Intervener Services for young children who are deaf-blind and their families.     

Academic intrinsic motivation in young elementary school children.

Two studies, 1 longitudinal and 1 cross-sectional, demonstrate that for young elementary school children, academic intrinsic motivation is a reliable, valid, and significant construct. It was positively related to achievement, IQ, and perception of competence, and inversely related to anxiety. Academic intrinsic motivation at age 9 was significantly predicted by motivation measured 1 and 2 years earlier, above and beyond the contribution of IQ and achievement. Children with higher academic intrinsic motivation at ages 7 and 8 were more likely to show higher motivation at age 9. Whereas young children could reliably distinguish between subject areas of academic intrinsic motivation, only math motivation showed consistently specific relations to other math criteria. Findings are discussed with regard to developmental theories of intrinsic motivation and the significance of academic intrinsic motivation for children's education. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health services for children: The state of the art.

Throughout this century, people in the United States have been concerned about the serious deficiencies in the mental health care of our children. Despite eloquent needs assessment and recommendations for remediation, most of the unserved needs and deficiencies of our mental-health-care-delivery system remain the same. This article reviews the current status of mental health services to children, youth, and families to highlight the necessity of an integrated system of mental health care. The development of a continuum of care that is coordinated across the mental health and non-mental-health systems that naturally occur in all children's lives has the potential to vastly improve mental health services to children, youth, and families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nutrient intake and dental health in school children

Diet refers to the customary allowance of food and drink taken by a person from day to day. The diet may affect dental caries by reacting with the enamel surface and by serving as a substrate for cariogenic microorganisms. This study examined the role of specific nutrients in the caries experience of elementary school children. 120 children aged between 6-11, who attended the Pedodontics Department of Marmara University, Faculty of Dentistry for routine dental treatment received a dental examination, parent interview, and a 3-day diet diary. The diary was completed adequately for 100 children (83%). The average daily intake of nutrients were computed and total sugar consumption and Ca/P ratio were calculated. Each child's gender, age, fluoride history, socio-economic state of the family, previous dental experience, brushing habit, and nutrient intake were examined as independent variables. No association was apparent between dental caries and the intake of specific nutrients or Ca/P ratio, except with total sugar consumption.     

Implications for health services

Health services for older people in the NHS have developed pragmatically, and reflect the nature of disease in later life and the need to agree objectives of care with patients. Although services are likely to be able to cope with the immediate future, the growth of the elderly population anticipated from 2030 calls for long-term planning and research. The issue of funding requires immediate political thought and action. Scientifically the focus needs to be on maximizing the efficiency of services by health services research and reducing the incidence of disability in later life through research on its biological and social determinants. Senescence is a progressive loss of adaptability due to an interaction between intrinsic (genetic) processes with extrinsic factors in environment and lifestyle. There are grounds for postulating that a policy of postponement of the onset of disability, by modifications of lifestyle and environment, could reduce the average duration of disability before death. The new political structures of Europe offer under exploited-unexploited opportunities for the necessary research.     

Validation of a screening instrument for young children with teacher assessment of school performance.

Attempted to identify a screening instrument that would agree with teacher judgments of high- and low-performing students to increase the relevance of educational programs for young children. A group of children was observed and tested, and the results were compared with teacher judgments from kindergarten through 3rd grade. During the 1st yr of the study, 32 high-performing and 32 low-performing students were identified by 11 kindergarten teachers. The 1st-yr results were validated with a 2nd group of 208 kindergarten children. The initial group of 64 Ss was subsequently evaluated by their 1st-, 2nd-, and 3rd-grade teachers without knowing the results of the previous year's screening. It was found that the Basic School Skills Inventory-Screen can be used by the teacher to quickly gather behavior samples before he/she has had sufficient exposure to the child to make more informed decisions. Results were predictive of subsequent school performance. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of health services by children and young people according to ethnicity and social class: secondary analysis of a national survey

OBJECTIVE: To assess whether equity is achieved in use of general practitioner, outpatient, and inpatient services by children and young people according to their ethnic group and socioeconomic background. DESIGN: Secondary analysis of the British general household survey, 1991-94. SUBJECTS: 20 473 children and young people aged between 0 and 19 years. MAIN OUTCOME MEASURES: Consultations with a general practitioner within a two week period, outpatient attendances within a three month period, and inpatient stays during the past year. RESULTS: There were no significant class differences in the use of health services by children and young people, and there was little evidence of variation in use of health services according to housing tenure and parental work status. South Asian children and young people used general practitioner services more than any other ethnic group after controlling for socioeconomic background and perceived health status, but the use of hospital outpatient and inpatient services was significantly lower for children and young people from all minority ethnic groups compared with the white population. CONCLUSIONS: Our results differ from previous studies, which have reported significant class differences in use of health services for other age groups. We found no evidence that children and young people's use of health services varied according to their socioeconomic status, suggesting that equity has been achieved. A child or young person's ethnic origin, however, was clearly associated with use of general practitioner and hospital services, which could imply that children and young people from minority ethnic groups receive a poorer quality of health care than other children and young people.     

Addressing the barriers to mental health services for inner city children and their caretakers

This paper will outline a series of three research studies meant to identify factors related to child mental health service usage and barriers to help seeking for urban minority children and their caretakers. In addition, this paper will describe the systematic development and evaluation of a telephone intervention strategy aimed towards increasing overall attendance at initial intake appointments at an urban child serving agency. The first study explores differences in demographic variables, for two groups of children (n = 450), those that came to an initial intake interview and those that requested child mental health services, but failed to come to any scheduled appointments. The second study evaluates a telephone engagement intervention meant to increase initial attendance (n = 54). Finally, the third study, more rigorously evaluates the impact of an intensive telephone intervention on initial attendance rates by randomly assigning families to the more focused telephone intervention or a "business as usual" telephone screening (n = 108).     

Minimal criteria of epidemiologic studies of dental health of school children]

OBJECTIVE: To understand the developmental psychopathology of eating disorders, it is crucial to explain the large gender discrepancy in the rates of these disorders, especially anorexia nervosa and bulimia nervosa. In this paper, meta-analysis was used to examine the relationship between gender role adherence and the existence of eating problems. METHOD: Of the 69 studies examined, 22 contained data deemed valid for the analyses. Measures of difference (d) and homogeneity were calculated. These studies used the Personal Attributes Questionnaire (PAQ) or the Bem Sex Role Inventory (BSRI) to measure gender role adherence. RESULTS: Findings indicated a small, heterogeneous positive relationship between femininity and eating problems and a small, heterogeneous negative relationship between masculinity and eating problems. Studies that used a clinical sample showed a larger discrepancy in masculinity scores between the eating-disordered and the control groups than did studies using surveys to identify eating problems. Six studies measured gender role traditionalism. The eating-disordered groups did not differ significantly on these measures compared to the control groups. DISCUSSION: Despite construct validity problems with the use of the PAQ and the BSRI in this area of study, data suggest that gender role is related to eating problems. Crucial aspects of femininity likely to be related to eating problems need to be operationalized and their link to eating disorders examined.